<div id="content">
    <h3><a href="?p=home&t=student">Geoplaza</a><a href="?p=home&t=student"> &rsaquo;&rsaquo; studenten</a> &rsaquo;&rsaquo; profiel aanmaken</h3>
    <hr>
    <p>
        Met dit formulier kun je je aanmelden. Vul het formulier zo volledig mogelijk in.
    </p>

    <div id="signup">
        <form action="?p=profielLib&t=student" method="post">

            <fieldset><label for="voornaam">Voornaam</label>
                <input name="voornaam" id="voornaam" type="text" /></fieldset>

            <fieldset><label for="achternaam">Achternaam</label>
                <input name="achternaam" id="achternaam" type="text" /></fieldset>

            <fieldset><label for="geslacht">Ik ben een</label>
                <select name="geslacht">
                    <option value="man">Man</option>
                    <option value="vrouw">Vrouw</option>
                </select>
            </fieldset>

            <fieldset><label for="dob">Geboortedatum</label>
                <select name="geboortedag">
                    <option>1</option>
                    <option>2</option>
                    <option>3</option>
                    <option>4</option>
                    <option>5</option>
                    <option>6</option>
                    <option>7</option>
                    <option>8</option>
                    <option>9</option>
                    <option>10</option>
                    <option>11</option>
                    <option>12</option>
                    <option>13</option>
                    <option>14</option>
                    <option>15</option>
                    <option>16</option>
                    <option>17</option>
                    <option>18</option>
                    <option>19</option>
                    <option>20</option>
                    <option>21</option>
                    <option>22</option>
                    <option>23</option>
                    <option>24</option>
                    <option>25</option>
                    <option>26</option>
                    <option>27</option>
                    <option>28</option>
                    <option>29</option>
                    <option>30</option>
                    <option>31</option>
                </select>
                <select name="geboortemaand">
                    <option>1</option>
                    <option>2</option>
                    <option>3</option>
                    <option>4</option>
                    <option>5</option>
                    <option>6</option>
                    <option>7</option>
                    <option>8</option>
                    <option>9</option>
                    <option>10</option>
                    <option>11</option>
                    <option>12</option>
                </select>
                <select name="geboortejaar">
                    <?php
                    $datum = date('Y');
                    $start = $datum - 100;
                    while ($start <= $datum) {
                    ?>
                        <option>
                        <?php
                        print ($start);
                        $start++;
                        ?>
                    </option>
                    <?php }
                    ?>
                </select>
            </fieldset>

            <fieldset><label for="adres">Adres</label>
                <input name="adres" id="adres" type="text"/></fieldset>

            <fieldset><label for="postcode">Postcode</label>
                <input name="postcode" id="postcode" type="text"/></fieldset>

            <fieldset><label for="woonplaats">Woonplaats</label>
                <input name="woonplaats" id="woonplaats" type="text"/></fieldset>

            <fieldset><label for="province">Provincie</label>
                <select name="province">
                    <option value="Groningen">Groningen</option>
                    <option value="Friesland">Friesland</option>
                    <option value="Drenthe">Drenthe</option>
                    <option value="Overijssel">Overijssel</option>
                    <option value="Flevoland">Flevoland</option>
                    <option value="Gelderland">Gelderland</option>
                    <option value="Utrecht">Utrecht</option>
                    <option value="Noord-Holland">Noord-Holland</option>
                    <option value="Zuid-Holland">Zuid-Holland</option>
                    <option value="Zeeland">Zeeland</option>
                    <option value="Noord-Barabant">Noord-Barabant</option>
                    <option value="Limburg">Limburg</option>
                </select>
            </fieldset>

            <fieldset><label for="telefoon">Telefoon</label>
                <input name="telefoon" id="telefoon" type="text" /></fieldset>

            <fieldset><label for="bio">Biography</label>
                <textarea name="bio" id="bio"></textarea></fieldset>

            <h3>Opleiding</h3>
            <hr>
            <fieldset><label for="opleiding">Huidige opleiding </label>
                <input name="opleiding" id="opleiding" type="text" /></fieldset>

            <fieldset class="chk"><label for="niveau">Niveau</label>
                <ul>
                    <li><input type="radio" name="niveau" value="MBO" checked>MBO</li>
                    <li><input type="radio" name="niveau" value="HBO">HBO</li>
                    <li><input type="radio" name="niveau" value="WO">WO</li>
                </ul>
            </fieldset>
            <fieldset><label for="school">Naam school</label>
                <input name="school" id="school" type="text" /></fieldset>
            <fieldset><label for="stagedatum">Voor de stage ik beschikbaar</label>
                <select name="stagedag">
                    <option>1</option>
                    <option>2</option>
                    <option>3</option>
                    <option>4</option>
                    <option>5</option>
                    <option>6</option>
                    <option>7</option>
                    <option>8</option>
                    <option>9</option>
                    <option>10</option>
                    <option>11</option>
                    <option>12</option>
                    <option>13</option>
                    <option>14</option>
                    <option>15</option>
                    <option>16</option>
                    <option>17</option>
                    <option>18</option>
                    <option>19</option>
                    <option>20</option>
                    <option>21</option>
                    <option>22</option>
                    <option>23</option>
                    <option>24</option>
                    <option>25</option>
                    <option>26</option>
                    <option>27</option>
                    <option>28</option>
                    <option>29</option>
                    <option>30</option>
                    <option>31</option>
                </select>
                <select name="stagemaand">
                    <option>1</option>
                    <option>2</option>
                    <option>3</option>
                    <option>4</option>
                    <option>5</option>
                    <option>6</option>
                    <option>7</option>
                    <option>8</option>
                    <option>9</option>
                    <option>10</option>
                    <option>11</option>
                    <option>12</option>
                </select>
                <select name="stagejaar">
                    <?php
                    $datum = date('Y');
                    $start = $datum + 4;
                    while ($datum <= $start) {
                    ?>
                        <option>
                        <?php
                        print ($datum);
                        $datum++;
                        ?>
                    </option>
                    <?php }
                    ?>
                </select>
            </fieldset>

            <h3>Inlog gegevens</h3>
            <hr>

            <fieldset><label for="email">Gebruikersnaam (je email)</label>
                <input name="email" id="email" type="text" /></fieldset>

            <fieldset><label for="wachtwoord">Wachtwoord</label>
                <input name="wachtwoord" id="wachtwoord" type="password" /></fieldset>

            <fieldset><label for="rewachtwoord">Bevestig wachtwoord</label>
                <input name="rewachtwoord" id="rewachtwoord" type="password" /></fieldset>

            <fieldset class="nolabel">
                <input type="submit" id="enrol" value="Enroll" disabled="disabled"  />
            </fieldset>
        </form>
    </div>

</div>